Endoscopic surgical clip applier and handle assemblies for use therewith

ABSTRACT

A handle assembly for use with a surgical instrument including a housing, a movable handle, a plunger, a first linkage, and a second linkage. The movable handle is pivotably mounted to the housing about a handle pin. The plunger is disposed at least partially within the housing. Distal translation of the plunger relative to the housing is configured to affect a function of the surgical instrument. The first linkage is disposed at least partially within the housing. A first portion of the first linkage is pivotable about the housing, and a second portion of the first linkage is slidable relative to the handle pin. The second linkage is disposed at least partially within the housing. A first portion of the second linkage is pivotable about the plunger, and a second portion of the second linkage is pivotable about a third portion of the first linkage.

CROSS-REFERENCE TO RELATED APPLICATIONS

This application claims the benefit of and priority to U.S. ProvisionalPatent Application No. 62/557,773 filed Sep. 13, 2017, the entiredisclosure of which is incorporated by reference herein.

BACKGROUND Technical Field

The present disclosure relates to surgical clip appliers. Moreparticularly, the present disclosure relates to endoscopic surgical clipappliers having handle assemblies configured to enhance the mechanicaladvantage while actuating its handle.

Description of Related Art

Endoscopic surgical staplers and surgical clip appliers are known in theart and are used for a number of distinct and useful surgicalprocedures. In the case of a laparoscopic surgical procedure, access tothe interior of an abdomen is achieved through narrow tubes or cannulasinserted through a small entrance incision in the skin. Minimallyinvasive procedures performed elsewhere in the body are often generallyreferred to as endoscopic procedures. Typically, a tube or cannuladevice is extended into the patient's body through the entrance incisionto provide an access port. The port allows the surgeon to insert anumber of different surgical instruments therethrough using a trocar andfor performing surgical procedures far removed from the incision.

During a majority of these procedures, the surgeon must often terminatethe flow of blood or another fluid through one or more vessels. Thesurgeon will often use a particular endoscopic surgical clip applier toapply a surgical clip to a blood vessel or another duct to prevent theflow of body fluids therethrough during the procedure.

Endoscopic surgical clip appliers having various sizes (e.g.,diameters), that are configured to apply a variety of diverse surgicalclips, are known in the art, and which are capable of applying a singleor multiple surgical clips during an entry to the body cavity. Suchsurgical clips are typically fabricated from a biocompatible materialand are usually compressed over a vessel. Once applied to the vessel,the compressed surgical clip terminates the flow of fluid therethrough.

Endoscopic surgical clip appliers that are able to apply multiple clipsin endoscopic or laparoscopic procedures during a single entry into thebody cavity are described in commonly-assigned U.S. Pat. Nos. 5,084,057and 5,100,420 to Green et al., which are both incorporated by referencein their entirety. Another multiple endoscopic surgical clip applier isdisclosed in commonly-assigned U.S. Pat. No. 5,607,436 by Pratt et al.,the contents of which is also hereby incorporated by reference herein inits entirety. These devices are typically, though not necessarily, usedduring a single surgical procedure. U.S. Pat. No. 5,695,502 to Pier etal., the disclosure of which is hereby incorporated by reference herein,discloses a resterilizable endoscopic surgical clip applier. Theendoscopic surgical clip applier advances and forms multiple clipsduring a single insertion into the body cavity. This resterilizableendoscopic surgical clip applier is configured to receive and cooperatewith an interchangeable clip magazine so as to advance and form multipleclips during a single entry into a body cavity.

During endoscopic or laparoscopic procedures it may be desirable and/ornecessary to use different size surgical clips or different configuredsurgical clips depending on the underlying tissue or vessels to beligated. In order to reduce overall costs of an endoscopic surgical clipapplier, it is desirable for a single endoscopic surgical clip applierto be loadable with and capable of firing different size surgical clipsas needed. Accordingly, a need exists for endoscopic surgical clipappliers that include handle assemblies configured for use with variousdifferent endoscopic assemblies having different clips loaded thereinand/or configured for performing various different surgical tasks.

Additionally, due to the force required to emplace surgical clips and/orthe density of the target tissue, for instance, it may be physicallydifficult to fully actuate the movable handle to help ensure properplacement of the surgical clips. Thus, it may also be desirable toincrease the mechanical advantage of actuating the movable handle of theclip applier, for example.

SUMMARY

As detailed herein and shown in the drawing figures, as is traditionalwhen referring to relative positioning on a surgical instrument, theterm “proximal” refers to the end of the apparatus or component thereofwhich is closer to the user and the term “distal” refers to the end ofthe apparatus or component thereof which is further away from the user.Further, to the extent consistent, any or all of the aspects andfeatures detailed herein may be used in conjunction with any or all ofthe other aspects and features detailed herein.

Provided in accordance with aspects of the present disclosure is ahandle assembly for use with a surgical instrument including a housing,a movable handle, a plunger, a first linkage, and a second linkage. Themovable handle is pivotably mounted to the housing about a handle pin.The plunger is disposed at least partially within the housing. Distaltranslation of the plunger relative to the housing is configured toaffect a function of the surgical instrument. The first linkage isdisposed at least partially within the housing. A first portion of thefirst linkage is pivotable about the housing, and a second portion ofthe first linkage is slidable relative to the handle pin. The secondlinkage is disposed at least partially within the housing. A firstportion of the second linkage is pivotable about the plunger, and asecond portion of the second linkage is pivotable about a third portionof the first linkage.

In disclosed embodiments, the second portion of the first linkageincludes a slot, and the handle pin is slidable within the slot.

In embodiments, the first portion of the second linkage is pivotableabout a plunger pin, and the plunger pin extends laterally from aproximal portion of the plunger.

It is also disclosed that the plunger defines a longitudinal axis, andthe handle pin is disposed along the longitudinal axis and proximally ofa proximal-most end of the plunger.

It is further disclosed that the second portion of the second linkage ispivotable about the third portion of the first linkage and about alinkage pin. In embodiments, when the movable handle is in anon-actuated position, the linkage pin is disposed proximally of thehandle pin. When the movable handle is in an actuated position, thelinkage pin is disposed distally of the handle pin. When the movablehandle is in a fully actuated position, the linkage pin and the handlepin are longitudinally aligned.

In disclosed embodiments, the second linkage includes a V-like portionconfigured to prevent interference between the second linkage and thehandle pin. The V-like portion of the second linkage is closer to thesecond portion of the second linkage than the first portion of thesecond linkage.

It is disclosed that the plunger pin may be disposed distally of thehandle pin throughout an entire actuation stroke of the movable handle.It is further disclosed that the plunger pin may be disposed distally ofthe linkage pin throughout an entire actuation stroke of the movablehandle.

It is also disclosed that the first linkage may be free from contactwith the plunger throughout an entire actuation stroke of the movablehandle.

In disclosed embodiments, the plunger defines a longitudinal axis, andthe handle pin and the linkage pin are disposed on the same side of thelongitudinal axis as a majority of the movable handle throughout anentire actuation stroke of the movable handle.

BRIEF DESCRIPTION OF THE DRAWINGS

Aspects and features of the presently-disclosed endoscopic surgical clipappliers are described in detail with reference to the drawing figureswherein like reference numerals identify similar or identical structuralelements and:

FIG. 1 is a perspective view of the proximal portion of an endoscopicsurgical clip applier provided in accordance with the present disclosureincluding a handle assembly having an endoscopic assembly engagedtherewith;

FIG. 2 is perspective view of the endoscopic surgical clip applier ofFIG. 1 with the endoscopic assembly removed from the handle assembly;

FIG. 3 is an enlarged, perspective view of the area of detail indicatedas “3” in FIG. 2;

FIG. 4 is a transverse, cross-sectional view taken across section line4-4 in FIG. 3;

FIG. 5 is a transverse, cross-sectional view taken across section line5-5 in FIG. 3;

FIG. 6 is a transverse, cross-sectional view taken across section line6-6 in FIG. 1;

FIG. 7 is a longitudinal, cross-sectional view taken across section line7-7 in FIG. 6;

FIG. 8 is a longitudinal, cross-sectional view of handle assembly ofFIG. 1;

FIG. 9 is an exploded view of the handle assembly of FIG. 1;

FIG. 10 is a perspective view of the handle assembly of FIG. 1 with aportion of the housing removed to illustrate the internal componentstherein;

FIG. 11 is a perspective view of the internal assemblies of the handleassembly of FIG. 1;

FIG. 12 is an enlarged, longitudinal, cross-sectional view of the areaof detail indicated as “12” in FIG. 8;

FIG. 13 is an enlarged, perspective view of the area of detail indicatedas “13” in FIG. 10;

FIG. 14 is an enlarged, perspective view of the area of detail indicatedas “14” in FIG. 11;

FIG. 15 is a perspective view of another endoscopic assembly configuredfor use with the handle assembly of FIG. 1;

FIG. 16 is an enlarged, perspective view of the distal portion of theendoscopic assembly of FIG. 15;

FIG. 17 is an enlarged, perspective view of the proximal portion of theendoscopic assembly of FIG. 15;

FIG. 18 is an enlarged, perspective, of the proximal portion of theendoscopic assembly of FIG. 15 with a portion of the outer housing shownin phantom to illustrate the internal components therein;

FIG. 19 is a longitudinal, cross-sectional view of the endoscopicassembly of FIG. 15;

FIG. 20 is an enlarged, longitudinal, cross-sectional view of theproximal portion of the endoscopic assembly of FIG. 15;

FIG. 21 is an enlarged, longitudinal, cross-sectional view illustratingthe operable engagement between the handle assembly of FIG. 1 and theendoscopic assembly of FIG. 15;

FIG. 22 is a perspective view of another endoscopic assembly configuredfor use with the handle assembly of FIG. 1;

FIG. 23 is an enlarged, perspective view of the distal portion of theendoscopic assembly of FIG. 22;

FIG. 24 is an enlarged, perspective view of the proximal portion of theendoscopic assembly of FIG. 22;

FIG. 25 is an enlarged, perspective, of the proximal portion of theendoscopic assembly of FIG. 22 with a portion of the outer housing shownin phantom to illustrate the internal components therein;

FIG. 26 is a longitudinal, cross-sectional view of the endoscopicassembly of FIG. 22;

FIG. 27 is a longitudinal, cross-sectional view of the proximal portionof the endoscopic assembly of FIG. 22;

FIG. 28 is an enlarged, longitudinal, cross-sectional view illustratingthe operable engagement between the handle assembly of FIG. 1 and theendoscopic assembly of FIG. 22;

FIG. 29 is a top, cross-sectional view illustrating an alternateembodiment of an endoscopic assembly provided in accordance with thepresent disclosure;

FIG. 30 is a perspective view of a handle assembly of an endoscopicassembly provided in accordance with another embodiment of the presentdisclosure;

FIG. 31 is a perspective, cut-away view of the handle assembly of FIG.30;

FIG. 32 is a side, cut-away view of the handle assembly of FIGS. 30 and31 shown in a first position;

FIG. 33 is a side, cut-away view of the handle assembly of FIGS. 30-32shown in a second position;

FIG. 34 is a side, cut-away view of the handle assembly of FIGS. 30-33shown in a third position; and

FIG. 35 is a graph illustrating the amount of force required to actuatea movable handle of the handle assembly of FIGS. 30-34 with respect totime; and

FIG. 36 is a schematic illustration of a robotic surgical systemconfigured for use in accordance with the present disclosure.

DETAILED DESCRIPTION OF EMBODIMENTS

Turning to FIGS. 1 and 2, an endoscopic surgical clip applier providedin accordance with the present disclosure is identified by referencenumeral 10. Surgical clip applier 10 generally includes a handleassembly 100 and a plurality of endoscopic assemblies 200 selectivelyconnectable to and extendable distally from handle assembly 100. Handleassembly 100 is advantageously configured to operate each of theplurality of endoscopic assemblies 200, upon connection thereto, and maybe configured as a sterilizable, reusable component such that handleassembly 100 may be repeatedly used with different and/or additionalendoscopic assemblies 200 during the course of one or more surgicalprocedures. The endoscopic assemblies 200 may be configured assingle-use disposable components, limited-use disposable components, orreusable components, depending upon a particular purpose and/or theconfiguration of the particular endoscopic assembly 200. In eitherconfiguration, the need for multiple handle assemblies 100 is obviatedand, instead, the surgeon need only select an appropriate endoscopicassembly 200 and connect that endoscopic assembly 200 to handle assembly100 in preparation for use.

Handle assembly 100 is initially detailed for use in connection with ageneric endoscopic assembly 200 that includes features common to anyendoscopic assembly usable with handle assembly 100. Exemplaryembodiments of particular endoscopic assemblies, e.g., endoscopicassembly 300 (FIG. 15) and endoscopic assembly 400 (FIG. 22), arethereafter detailed below. Endoscopic assembly 300 (FIG. 15), forexample, is configured for grasping and manipulating tissue, retrievinga surgical clip, and firing and forming the surgical clip about tissue.Endoscopic assembly 400 (FIG. 22), as another example, includes at leastone surgical clip loaded therein and is configured to sequentially fireand form the at least one surgical clip about tissue. It is alsoenvisioned that various other endoscopic assemblies for performingvarious different surgical tasks and/or having various differentconfigurations may be provided for use with handle assembly 100.

Continuing with reference to FIGS. 1 and 2, as noted above, endoscopicassembly 200 is configured to selectively connect to and extend distallyfrom handle assembly 100. Endoscopic assembly 200 includes a proximalhub 210 configured for insertion into and releasable engagement withinhandle assembly 100, an elongated shaft 220 extending distally fromproximal hub 210, and an end effector assembly (not shown) disposed atthe distal end of elongated shaft 220. Internal drive components (notshown) extend through proximal hub 210 and elongated shaft 220 so as tooperably couple the end effector assembly (not shown) with handleassembly 100 upon engagement of endoscopic assembly 200 with handleassembly 100, e.g., to enable performing the one or more surgical tasksof the endoscopic assembly 200. Proximal hub 210 defines a generallytubular configuration and includes a longitudinally-extending slot 212defined therein and an annular groove 214 defined therein.Longitudinally-extending slot 212 defines an open proximal end 213.Annular groove 214 extends circumferentially about proximal hub 210 andintersects longitudinally-extending slot 212, although othernon-intersecting configurations are also contemplated.

Referring additionally to FIGS. 3-5, handle assembly 100 includes areceiver assembly 170 configured to receive proximal hub 210 ofendoscopic assembly 200 and enable releasable engagement of endoscopicassembly 200 with handle assembly 100. Receiver assembly 170 includes anouter collar 172 and an inner tubular member 174. Inner tubular member174 defines an interior diameter slightly larger than an exteriordiameter of proximal hub 210 of endoscopic assembly 200 to enableslidable insertion of proximal hub 210 into inner tubular member 174without significant play therebetween. Inner tubular member 174 furtherincludes a plurality of apertures 176 defined therethrough andpositioned circumferentially about inner tubular member 174. Apertures176 define reduced interior openings 177 a as compared to the exterioropenings 177 b thereof. A ball bearing 178 is disposed within each ofthe apertures 176. Although a portion of each ball bearing 178 protrudesinwardly through the reduced interior opening 177 a of its respectiveaperture 176, the reduced interior openings 177 a inhibit ball bearings178 from passing entirely therethrough. Outer collar 172 is positionedso as to block the exterior openings 177 b of apertures, therebyretaining ball bearings 178 within apertures 176 between outer collar172 and the reduced interior openings 177 a (except for the portions ofball bearings 178 extending through the reduced interior openings 177a).

A pin 180 extends through a pin aperture 182 defined within innertubular member 174 and at least partially through a pin slot 184 definedwithin outer collar 172. Pin 180 extends at least partially into theinterior of inner tubular member 174 and, as detailed below, isconfigured to facilitate alignment of endoscopic assembly 200 uponinsertion of endoscopic assembly 200 into handle assembly 100. Pin 180is further configured to retain outer collar 172 and inner tubularmember 174 in fixed rotational orientation relative to one another.Outer collar 172 is engaged with rotation knob 190 of handle assembly100 in fixed rotational orientation such that, with pin 180 rotatablycoupling outer collar 172 and inner tubular member 174, rotation ofrotation knob 190 can be effected to similarly rotate receiver assembly170. Rotation knob 190 includes an alignment indicator 192 disposedthereon that is aligned with pin 180 to enable alignment of endoscopicassembly 200 with receiver assembly 170 without the need to directlyview the position of pin 180.

With reference to FIGS. 1, 2, 6 and 7, in order to engage endoscopicassembly 200 with handle assembly 100, endoscopic assembly 200 isoriented such that longitudinally-extending slot 212 thereof is alignedwith pin 180 of receiver assembly 170. As noted above, rather thanhaving to view pin 180 directly, alignment of longitudinally-extendingslot 212 and pin 180 can be achieved via aligninglongitudinally-extending slot 212 with alignment indicator 192 ofrotation knob 190 of handle assembly 100. Once alignment has beenachieved, proximal hub 210 of endoscopic assembly 200 is slid proximallyinto inner tubular member 174 of receiver assembly 170. Alignment oflongitudinally-extending slot 212 and pin 180 ensures that, uponproximal sliding of proximal hub 210 into inner tubular member 174, pin180 is translated through longitudinally-extending slot 212.

As proximal hub 210 is slid proximally into inner tubular member 174,ball bearings 178 apply radially-inward force on the exterior ofproximal hub 210 causing proximal hub 210, outer collar 172, innertubular member 174, and/or ball bearings 178 to move or flex toaccommodate proximal hub 210 between ball bearings 178. Ball bearings178 are permitted to rotate within apertures 176 as proximal hub 210 isslid proximally into inner tubular member 174, reducing friction andpermitting relatively easy sliding of proximal hub 210 into innertubular member 174. Upon full insertion of proximal hub 210 into innertubular member 174, e.g., upon pin 180 reaching the closed, distal endof longitudinally-extending slot 212, ball bearings 178 are moved intoposition about annular groove 214. As a result of the radially-inwardforce imparted by ball bearings 178, once the fully inserted positionhas been achieved, ball bearings 178 are urged into annular groove 214to thereby releasably lock proximal hub 210 of endoscopic assembly 200in engagement within receiver assembly 170 of handle assembly 100. Theoperable coupling of endoscopic assembly 200 with handle assembly 100 toenable operation thereof to perform one or more surgical tasks dependsupon the type of endoscopic assembly 200 engaged with handle assembly100 and will be detailed below with respect to exemplary endoscopicassemblies 300 (FIG. 15) and 400 (FIG. 22).

In order to remove endoscopic assembly 200 from handle assembly 100,endoscopic assembly 200 is pulled distally relative to handle assembly100 under sufficient urging so as to dislodge ball bearings 178 fromannular groove 214, thus permitting proximal hub 210 of endoscopicassembly 200 to be slid distally out of receiver assembly 170 of handleassembly 100.

Referring to FIGS. 1, 2, and 8-10, handle assembly 100 generallyincludes a housing 110, a trigger assembly 120 pivotably coupled tohousing 110, a ratcheting drive assembly 130 operably coupled to triggerassembly 120, a bypass assembly 150 operably coupled to ratcheting driveassembly 130, receiver assembly 170 which extends distally from housing110, and rotation knob 190 which is operably disposed about receiverassembly 170.

Housing 110 defines a body portion 111 and a fixed handle portion 112extending downwardly from body portion 111. Housing 110 is formed fromfirst and second housing components 113 a, 113 b secured to one anothervia pin-post engagement, although first and second housing components113 a, 113 b may alternatively be secured in any other suitable manner,e.g., ultrasonic welding, gluing, other mechanical engagement, etc.Housing 110 is configured to house the internal working components ofhandle assembly 100. Body portion 111 includes a distal nose 114defining an annular slot 115 on the interior thereof. More specifically,first and second housing components 113 a, 113 b each define asemi-annular slot portion such that, when first and second housingcomponents 113 a, 113 b cooperate to form housing 110, annular slot 115is formed. Receiver assembly 170 of handle assembly 100 includes aretention clip 186 disposed about the proximal end of inner tubularmember 174 thereof. Retention clip 186 is captured within annular slot115 defined within distal nose 114 of housing 110, e.g., upon engagementof first and second housing components 113 a, 113 b with one another.Retention clip 186 is captured within annular slot 115 to rotatablyengage receiver assembly 170 with housing 110. Rotation knob 190 ofhandle assembly 100 is operably engaged about receiver assembly 170,e.g., via outer collar 172, biasing member 194, and elastomeric C-ring196, in fixed rotational orientation relative thereto such that rotationof rotation knob 190 relative to housing 110 effects similar rotation ofreceiver assembly 170 relative to housing 110. Thus, with endoscopicassembly 200 engaged within receiver assembly 170, rotation knob 190 maybe rotated relative to housing 100 to similarly rotate endoscopicassembly 200 relative to housing 110.

Body portion 111 of housing 110 further includes an internal pivot post116 extending transversely between housing components 113 a, 113 b and alongitudinally-extending guide track 117 defined within one or both ofhousing components 113 a, 113 b, the importance of each of which isdetailed below. Fixed handle portion 112 of housing 110 is configured tofacilitate grasping of handle assembly 100 and manipulation thereof andis monolithically formed with body portion 111, although otherconfigurations are also contemplated.

With additional reference to FIG. 11, trigger assembly 120 generallyincludes a trigger 122, a biasing member 127, and a linkage 128. Trigger122 includes a grasping portion 123, an intermediate pivot portion 124,and a proximal extension portion 125. Grasping portion 123 of trigger122 extend downwardly from body portion 111 of housing 110 in opposedrelation relative to fixed handle portion 112 of housing 110. Graspingportion 123 is configured to facilitate grasping and manipulation oftrigger 122. Intermediate pivot portion 124 of trigger 122 is at leastpartially disposed within housing 110 and defines a pivot aperture 126 athat is configured to receive pivot post 116 of housing 110 so as toenable pivoting of trigger 122 about pivot post 116 and relative tohousing 110, e.g., between an un-actuated position, wherein graspingportion 123 of trigger 122 is spaced-apart relative to fixed handleportion 112, and an actuated position, wherein grasping portion 123 oftrigger 122 is approximated relative to fixed handle portion 112.

Proximal extension portion 125 of trigger 122 of trigger assembly 120 isdisposed on an opposite side of intermediate pivot portion 124 and,thus, pivot post 116, as compared to grasping portion 123 of trigger122. As such, pivoting of grasping portion 123 proximally, e.g., towardsthe actuated position, urges proximal extension portion 125 distally.Proximal extension portion 125 includes a first aperture 126 bconfigured to receive a first end of biasing member 127, and a pair ofsecond apertures 126 c configured to receive a first pin 129 a forpivotably coupling the proximal end of linkage 128 and proximalextension portion 125 of trigger 122 with each other. The second end ofbiasing member 127 is engaged about an arm 118 extending transverselywithin fixed handle portion 112. Biasing member 127 is disposed in anat-rest condition in the un-actuated position of grasping portion 123 oftrigger 122. Pivoting of grasping portion 123 towards the actuatedposition elongates biasing member 127 storing energy therein such that,upon release of grasping portion 123, grasping portion 123 is returnedtowards the un-actuated position under the bias of biasing member 127.Although illustrated as an extension coil spring, biasing member 127 maydefine any suitable configuration for biasing grasping portion 123 oftrigger 122 towards the un-actuated position.

As noted above, linkage 128 is coupled at its proximal end to proximalextension portion 125 of trigger 122 via first pin 129 a. Linkage 128 isalso pivotably coupled, at its distal end, to proximal extension 134 ofdrive bar 132 of ratcheting drive assembly 130 via a second pin 129 b.Second pin 129 b extends outwardly from either or both sides of proximalextension 134 of drive bar 132 and is received within thelongitudinally-extending guide track(s) 117 defined within housingcomponent 113 a and/or housing component 113 b. As a result of thisconfiguration, pivoting of grasping portion 123 towards the actuatedposition urges proximal extension portion 125 distally which, in turn,urges linkage 128 distally such that second pin 129 b is translateddistally through longitudinally-extending guide track(s) 117.

Continuing with reference to FIGS. 1, 2, and 8-11, ratcheting driveassembly 130 of handle assembly 100 includes a drive bar 132 and a pawlassembly 140. Drive bar 132 includes a proximal extension 134, a ratchetrack 136, and distal and proximal recesses 138, 139, respectively.Proximal extension 134 is disposed at the proximal end of the drive bar132 and defines an aperture 135 configured to receive second pin 129 bof trigger assembly 120 so as to pivotably couple the distal end oflinkage 128 and drive bar 132 with one another, as noted above. As such,upon pivoting of grasping portion 123 towards the actuated position tourge second pin 129 b distally through longitudinally-extending guidetrack(s) 117, drive bar 132 is translated distally through body portion111 of housing 110. Ratchet rack 136 of drive bar 132 defines aplurality of teeth 137 and extends longitudinally along drive bar 132 onan upper surface thereof. Distal and proximal recesses 138, 139 aredefined by cut-outs formed in drive bar 132 and are positioned distallyadjacent ratchet rack 136 and proximally adjacent ratchet rack 136,respectively.

Referring also to FIG. 12, pawl assembly 140 of ratcheting driveassembly 130 includes a ratchet pawl 142, a pawl pin 144, and a pawlbiasing member 146. Ratchet pawl 142 is pivotably coupled to bodyportion 111 of housing 110 by pawl pin 144 so as to enable operableengagement of ratchet pawl 142 with ratchet rack 136 when an endoscopicassembly 200 that uses the ratcheting function is connected to handleassembly 100, and to enable pivoting of ratchet pawl 142 to a bypassposition when a endoscopic assembly 200 that does not use the ratchetingfunction is connected to handle assembly 100. Ratchet pawl 142 furtherincludes a pair of outwardly-extending tabs 143 extending transverselyfrom either side thereof, the importance of which are detailed below.

Pawl biasing member 146 of pawl assembly 140 is coupled between ratchetpawl 142 and body portion 111 of housing 110 so as to bias ratchet pawl142 towards a use position and away from the bypass position. In the useposition, ratchet pawl 142 is oriented to operably engage ratchet rack136 upon distal advancement of drive bar 132. However, in theproximal-most position of drive bar 132, corresponding to theun-actuated position of trigger 122, ratchet pawl 142 is disposed atleast partially within distal recess 138 of drive bar 132. Accordingly,at least initially, ratchet pawl 142 is disengaged from ratchet rack136.

With reference to FIGS. 8-14, bypass assembly 150 is operably positionedbetween pawl assembly 140 and receiver assembly 170 and is configured,in response to engagement of handle assembly 100 with an endoscopicassembly 200 that does not use the ratcheting function, to pivot ratchetpawl 142 to the bypass position, thereby inhibiting ratcheting uponadvancement of drive bar 132. When an endoscopic assembly 200 that usesthe ratcheting function is connected to handle assembly 100, bypassassembly 150 remains idle such that ratchet pawl 142 remains in the useposition to enable ratcheting of ratchet pawl 142 along ratchet rack 136upon advancement of drive bar 132.

Bypass assembly 150 includes a sleeve 152, a biasing member 154, and acamming clip 156. Sleeve 152 extends into the proximal end of innertubular member 174 of receiver assembly 170 and is disposed about thedistal end of drive bar 132 of drive assembly 130 in slidable relationrelative to both inner tubular member 174 and drive bar 132. Biasingmember 154 is disposed within inner tubular member 174 of receiverassembly 170 and about sleeve 152. More specifically, biasing member 154is retained about sleeve 152 between a distal rim 153 of sleeve 152 andan annular shoulder 179 defined within the interior of inner tubularmember 174 at the proximal end thereof. As a result of thisconfiguration, biasing member 154 biases sleeve 152 proximally into theinterior of inner tubular member 174. Distal rim 153 of sleeve 152 isradially-spaced from the interior wall defining inner tubular member 174so as to define an annular spacing “A1” therebetween. Sleeve 152 furtherdefines an internal diameter “D1.”

Camming clip 156 of bypass assembly 150 is engaged within an annulargroove 157 defined about the exterior of sleeve 152 towards the proximalend thereof. Camming clip 156 is sufficiently dimensioned so as toinhibit passage into the interior of inner tubular member 174 and, thus,inhibits sleeve 152 from fully entering inner tubular member 174 underthe bias of biasing member 154. Camming clip 156 further include a pairof opposed, inwardly extending fingers 158 at the free ends thereof.Fingers 158 are positioned such that, upon sufficient proximal urging ofsleeve 152 against the bias of biasing member 154, fingers 158 contactrespective tabs 143 of ratchet pawl 142. Thus, upon further proximalmovement of sleeve 152, fingers 158 urge respective tabs 143 proximally,ultimately such that ratchet pawl 142 is urged to rotate about pawl pin144 and against the bias of pawl biasing member 146 from the useposition to the bypass position.

Turning to FIGS. 15-21, and endoscopic assembly 300 provided inaccordance with the present disclosure and configured for use withhandle assembly 100 is shown. Endoscopic assembly 300 is configured fornon-ratcheting use and, thus, upon engagement of endoscopic assembly 300with handle assembly 100, as detailed below, ratchet pawl 142 is pivotedto and retained in the bypass position, thus enabling suchnon-ratcheting use. Endoscopic assembly 300 generally includes aproximal hub 310, an inner drive assembly 320 disposed within andextending through proximal hub 310, an elongated shaft 340 extendingdistally from proximal hub 310, and an end effector assembly 350including a pair of jaw members 360 a, 360 b disposed at the distal endof elongated shaft 340. Endoscopic assembly 300 is configured to graspand/or manipulate tissue, retrieve a surgical clip, and to close, fire,or form the surgical clip about tissue. It is contemplated thatendoscopic assembly 300 be configured to close, fire or form surgicalclips similar to those shown and described in U.S. Pat. No. 4,834,096,the entire contents of which are incorporated herein by reference.

With additional reference to FIGS. 1, 2, 6, and 7, proximal hub 310 ofendoscopic assembly 300 defines a generally tubular configuration and anexterior diameter slightly smaller than that of inner tubular member 174of receiver assembly 170 of handle assembly 100 to enable slidableinsertion of proximal hub 310 into inner tubular member 174 withoutsignificant play therebetween. Proximal hub 310 further includesfeatures similar to those detailed above with respect to endoscopicassembly 200 so as to enable engagement of proximal hub 310 withinreceiver assembly 170 of handle assembly 100 in a similar fashion. Morespecifically, proximal hub 310 a longitudinally-extending slot 311configured to receive pin 180 of receiver assembly 170 to ensure properalignment of endoscopic assembly 300 relative to handle assembly 100,and an annular groove 312 configured to receive at least a portion ofeach ball bearing 178 to releasably lock proximal hub 310 of endoscopicassembly 300 in engagement within receiver assembly 170 of handleassembly 100.

Referring again to FIGS. 15-21, proximal hub 310 of endoscopic assembly300 further defines an internal bore 313 having an open proximal end 314and a reduced-diameter distal opening as compared to the diameter ofbore 313 so as to define a shoulder 315 therebetween. A ferrule 316 isseated within the open proximal end of proximal hub 310 and securedtherein in any suitable fashion, e.g., welding, gluing, press-fitting,mechanical engagement, etc.

Ferrule 316 of proximal hub 310 defines an aperture 317 extendinglongitudinally therethrough and a proximally-facing surface 318surrounding aperture 317 such that proximally-facing surface 318 definesa ring-shaped configuration. Aperture 317 is disposed in communicationwith the interior of proximal hub 310 so as to provide access to innerdrive assembly 320, as detailed below, and defines a diameter “D2” thatis sufficiently large so as to permit slidable insertion of drive bar132 of ratcheting drive assembly 130 of handle assembly 100therethrough. However, diameter “D2” of aperture 317 is smaller thaninternal diameter “D1” of sleeve 152. Proximally-facing surface 318 offerrule 316 defines an annular width “A2” that is larger than theannular spacing “A1” defined between distal rim 153 of sleeve 152 andthe interior wall defining inner tubular member 174. As a result ofdiameter “D2” being smaller than diameter “D1” and annular width “A2”being larger than annular spacing “A1,” proximal hub 310 is inhibitedfrom passing into the interior of sleeve 152 and is likewise inhibitedfrom passing about the exterior of sleeve 152. Rather, upon proximalurging of proximal hub 310 of endoscopic assembly 300 into inner tubularmember 174 of receiver assembly 170 of handle assembly 100, e.g., toengage endoscopic assembly 300 with handle assembly 100,proximally-facing surface 318 of ferrule 316 eventually contacts distalrim 153 of sleeve 152 such that further proximal urging of proximal hub310 into inner tubular member 174 urges sleeve 152 proximally againstthe bias of biasing member 154.

As noted above, endoscopic assembly 300 is configured for non-ratchetinguse. Accordingly, the above-detailed configuration regarding therelative dimensions of the components of proximal hub 310 and those ofbypass assembly 150 ensures that proximal hub 310 urges ratchet pawl 142from the use position to the bypass position upon engagement ofendoscopic assembly 300 with handle assembly 100, thus disabling theratcheting components of ratcheting drive assembly 130. Morespecifically, with pin 180 received within longitudinally-extending slot311 and proximal hub 310 sliding proximally into inner tubular member174 of receiver assembly 170, but prior to engagement of ball bearings178 within annular groove 312, proximally-facing surface 318 of ferrule316 contacts distal rim 153 of sleeve 152 and urges sleeve 152proximally such that fingers 158 of camming clip 156 urge tabs 143 ofratchet pawl 142 proximally to thereby rotate ratchet pawl 142 aboutpawl pin 144 from the use position towards the bypass position.Accordingly, upon reaching the engaged position of proximal hub 310within inner tubular member 174, e.g., upon engagement of ball bearings178 within annular groove 312, as shown in FIG. 21, ferrule 316 hasurged sleeve 152 to a proximal-most position wherein ratchet pawl 142 ispivoted to and retained in the bypass position. Thus, when endoscopicassembly 300 is engaged with handle assembly 100, ratcheting ofratcheting drive assembly 130 is disabled.

Referring still to FIGS. 15-21, inner drive assembly 320 of endoscopicassembly 300 includes an inner shaft 322 slidably disposed within bothproximal hub 310 and elongated shaft 340 of endoscopic assembly 300.Inner shaft 322 includes a proximal end 323 supporting a transverse pin324 disposed within bore 313 of proximal hub 310, and a distal end 325supporting a cam pin 326 disposed towards the distal end 344 ofelongated shaft 340. As detailed below, cam pin 326 is disposed withincam slots (not shown) of jaw members 360 a, 360 b of end effectorassembly 350 to enable pivoting of jaw members 360 a, 360 b between openand closed positions in response to translation of inner shaft 322through elongated shaft 340.

Inner drive assembly 320 further includes a plunger 328 and first andsecond biasing members 330, 332, respectively. Plunger 328 is slidablydisposed within bore 313 of proximal hub 310 and is retained thereinbetween shoulder 315 and ferrule 316. Plunger 328 defines an internalcavity 329 within which transverse pin 324 of proximal end 323 of innershaft 322 is slidably confined.

First biasing member 330 of inner drive assembly 320 is disposed withininternal bore 313 of proximal hub 310 and interposed between shoulder315 of proximal hub 310 and transverse pin 324 of inner shaft 322. Firstbiasing member 330 has a first spring constant “K1” which is less than asecond spring constant “K2” of second biasing member 332, the importanceof which is detailed below. Second biasing member 332 is disposed withincavity 329 of plunger 328 and is interdisposed between transverse pin324 of inner shaft 322 and the proximal end of plunger 328. As detailedbelow, first and second biasing members 330, 332, respectively,facilitate appropriate translation of inner shaft 322 through proximalhub 310 and elongated shaft 340 to open and close jaw members 340 a, 340b, and to enable full actuation of trigger 122 (FIG. 1), as detailedbelow.

Elongated shaft 340 of endoscopic assembly 300 defines a generallytubular configuration and extends between and interconnects proximal hub310 and end effector assembly 350. More specifically, the proximal end342 of elongated shaft 340 is secured to proximal hub 310, while thedistal end 344 of elongated shaft 340 supports a clevis 346 configuredto pivotably engage jaw members 360 a, 360 b of end effector assembly350 at distal end 344 of elongated shaft 340 via a pivot pin 352.

End effector assembly 350, as noted above, includes first and second jawmembers 360 a, 360 b. Jaw members 360 a, 360 b are pivotably engaged toone another and clevis 346 via pivot pin 352 so as to permit pivoting ofjaw members 360 a, 360 b relative to one another and elongated shaft 340between an open position and a closed position. Each jaw member 360 a,360 b includes a respective proximal end 361 a, 361 b and a respectivedistal end 362 a, 362 b. The proximal end 361 a, 361 b of each jawmember 360 a, 360 b defines the cam slots (not shown) that areconfigured to receive cam pin 326 of inner shaft 322 such thattranslation of inner shaft 322 pivots jaw members 360 a, 360 b betweenthe open and closed positions. The distal ends 362 a, 362 b of jawmembers 360 a, 360 b are configured to receive and close, fire or form asurgical clip, e.g., a surgical clip similar to those shown anddescribed in U.S. Pat. No. 4,834,096, previously incorporated herein byreference.

Referring momentarily to FIG. 29, an alternate embodiment of inner driveassembly 320 is illustrated. In this embodiment, inner shaft 322 ofendoscopic assembly 300 is divided into a proximal portion 322′ and adistal portion 322″. A proximal end 322 a″ of distal portion 322″includes a bore 322 b″ defined therein configured to slidably receive anelongate member 322 b′ disposed on a distal end 322 a′ of proximalportion 322′. A transverse slot 322 c″ is defined through distal portion322″ of inner shaft 322 and is configured to slidably retain atransverse pin 320 a′. Transverse pin 320 a′ is fixedly retained withinan aperture (not shown) defined in the distal end 322 a′ of proximalportion 322′ using any suitable means, such as friction fit, welding,adhesives, or the like. A biasing member 320 b′ is disposed betweenproximal portion 322′ and distal portion 322″ of inner shaft 322 andacts upon proximal end 322 a″ of distal portion 322″ and an annularsurface 322 c′ disposed on a distal end 322 a′ of proximal portion 322′.In this manner, biasing member (e.g., a spring or the like) 320 b′ isinitially compressed such that proximal portion 322′ and distal portion322″ are maintained in spaced relation. Transverse pin 320 a′ inhibitsproximal portion 322′ and distal portion 322″ from being urged apart bybiasing member 320 b′ as transverse pin 320 b′ is at a proximal mostposition in the stroke of transverse slot 322 c″.

In operation, if the closure of the jaw members 360 a, 360 b shouldbecome stuck or otherwise prevented from closing completely (e.g., wherethe jaw members 360 a, 360 b are closing onto bone or onto anothersurgical clip), this over-load compensation system permits a forwardstroke of ratcheting drive assembly 130 of handle assembly 100 may befully completed (wherein a distal driving force of proximal portion 322′of inner shaft 322 axially compresses biasing member 320 b′ having aspring constant “K3”, which is greater than that of “K1” or “K2”) inorder to permit a re-set or a reversal of ratcheting drive assembly 130and permit trigger 122 to open.

The use of handle assembly 100 in conjunction with endoscopic assembly300 is now detailed with reference to FIGS. 8-21. Initially, endoscopicassembly 300 is engaged with handle assembly 100, as detailed above.Such engagement of endoscopic assembly 300 with handle assembly 100, asalso detailed above, effects pivoting of ratchet pawl 142 to andretention of ratchet pawl 142 in the bypass position. Once endoscopicassembly 300 and handle assembly 100 are engaged with ratchet pawl 142in the bypass position, handle assembly 100 and endoscopic assembly 300are together ready for use.

In use, trigger 122 is initially disposed in the un-actuated positionunder the bias of biasing member 127. With trigger 122 disposed in theun-actuated position, drive bar 132 is disposed in a proximal-mostposition. Further, inner shaft 322 is disposed in a proximal-mostposition under the bias of first and second biasing members 330, 332.Thus, jaw members 360 a, 360 b, initially, are disposed in the openposition. With jaw members 360 a, 360 b disposed in the open position, anew, unformed or open surgical clip (not shown) may be located or loadedwithin the distal ends 362 a, 362 b of jaw members 360 a, 360 b. Jawmembers 360 a, 360 b of end effector assembly 350 may be used toretrieve or pick-up a surgical clip from a clip holder (not shown), thesurgical clip may be manually loaded by the user, end effector assembly350 may be pre-loaded by the manufacturer, or the surgical clip may beplaced between jaw members 360 a, 360 b in any other suitable fashion.

In or to close, fire, or form the surgical clip loaded between jawmembers 360 a, 360 b, trigger 122 is urged from the un-actuated positionto the actuated position. More specifically, grasping portion 123 oftrigger 122 is pivoted towards fixed handle portion 112 of housing 110to urge linkage 128 distally which, in turn, urges drive bar 132distally through housing 110, receiver assembly 170, and into bore 313of proximal hub 310 of endoscopic assembly 300. As trigger 122 ispivoted further towards the actuated position, drive bar 132 eventuallycontacts plunger 328 of drive assembly 320 of endoscopic assembly 300.Due to first spring constant “K1” of first biasing member 330 being lessthan second spring constant “K2” of second biasing member 332, as drivebar 132 is initially urged into plunger 328, plunger 328 and inner shaft322 translate together distally such that first biasing member 330 iscompressed while second biasing member 332 remains substantiallyun-compressed.

As inner shaft 322 is translated distally, cam pin 326 is translatedthrough the cam slots of jaw members 360 a, 360 b to pivot jaw members360 a, 360 b towards the closed position to close and/or form thesurgical clip (not shown) loaded within end effector assembly 350. Campin 326 is advanced distally until cam pin 326 reaches an end of the camslots of jaw members 360 a, 360 b and/or until jaw members 360 a, 360 bare fully approximated against one another or fully closed on thesurgical clip. As can be appreciated, depending upon the particularendoscopic assembly used, the configuration of the surgical clip beingformed, and/or other factors, the required travel distance of innershaft 322 to fully form the surgical clip may vary. As the distance oftravel for trigger 122 between the un-actuated and actuated positionsdoes not vary, it is endoscopic assembly 300 that accounts for thisvariation, as detailed below.

Once jaw members 360 a, 360 b have been fully approximated against oneanother or fully closed on the surgical clip, and/or when cam pin 326has reached the end of the cam slots of jaw members 360 a, 360 b, innershaft 322 is no longer permitted to travel further distally. Thus, uponfurther distal urging of drive bar 132, e.g., to complete the actuationstroke of trigger 122, plunger 328 is advanced distally independently ofinner shaft 322 to compress second biasing member 332. Thus, thecompression of second biasing member 332 enables inner shaft 322 toremain in position while the full actuation stroke of trigger 122 iscompleted.

Once the surgical clip has been fully formed, trigger 122 may bereleased and allowed to return under bias to the un-actuated position,thereby pulling drive bar 132 back to its proximal-most position andallowing jaw members 360 a, 360 b to return to the open position.Thereafter, the above-detailed use may be repeated to close, fire, orform additional surgical clips. Additionally or alternatively, jawmembers 360 a, 360 b of end effector assembly 350 may be used to graspand/or manipulate tissue as desired prior to or after formation of oneor more surgical clips.

Turning to FIGS. 22-28, another endoscopic assembly 400 provided inaccordance with the present disclosure and configured for use withhandle assembly 100 (FIG. 1) is shown. Endoscopic assembly 400 isconfigured for ratcheting use and, thus, upon engagement of endoscopicassembly 400 with handle assembly 100, as detailed below, ratchet pawl142 remains in the use position to enable ratcheting use. Endoscopicassembly 400 generally includes a proximal hub 410, an elongated shaft420 extending distally from proximal hub 410, a drive assembly 430disposed within proximal hub 410 and elongated shaft 420, and a pair ofjaw members 460 a, 460 b supported at the distal end of elongated shaft420. Endoscopic assembly 400 is configured to close, fire, or form oneor more surgical clips about tissue. More specifically, it iscontemplated that endoscopic assembly 400 may be configured to close,fire or form surgical clips similar to those shown and described in U.S.Pat. No. 7,819,886 or 7,905,890, the entire contents of each of which isincorporated herein by reference.

With reference also to FIGS. 1, 2, 6, and 7, proximal hub 410 furtherincludes features similar to those detailed above with respect toendoscopic assembly 200 so as to enable engagement of proximal hub 410within receiver assembly 170 of handle assembly 100 in a similarfashion. More specifically, proximal hub 410 a longitudinally-extendingslot 411 configured to receive pin 180 of receiver assembly 170 toensure proper alignment of endoscopic assembly 400 relative to handleassembly 100, and an annular groove 412 configured to receive at least aportion of each ball bearing 178 to releasably lock proximal hub 410 ofendoscopic assembly 400 in engagement within receiver assembly 170 ofhandle assembly 100.

As noted above, endoscopic assembly 400 is configured for ratcheting useand, thus, upon engagement of endoscopic assembly 400 with handleassembly 100 ratchet pawl 142 remains in the use position to enableratcheting use. To allow such, proximal hub 410 defines a ring-shapedaperture 414 annularly disposed between the outer housing definingproximal hub 410 and plunger 435 of drive assembly 430, which isslidably disposed within proximal hub 410. This ring-shaped aperture 414is positioned and dimensioned to receive distal rim 153 of sleeve 152upon insertion of endoscopic assembly 400 into receiver assembly 170.Thus, upon insertion of proximal hub 410 of endoscopic assembly 400 intoinner tubular member 174 of receiver assembly 170 of handle assembly100, e.g., to engage endoscopic assembly 400 with handle assembly 100,distal rim 153 of sleeve 152 passes into proximal hub 410 throughring-shaped aperture 414 undisturbed such that sleeve 152 is maintainedin its distal-most position under the bias of biasing member 154. Withsleeve 152 in its distal-most position, ratchet pawl 142 remains in theuse position, thus enabling ratcheting use of ratcheting drive assembly130 of handle assembly 100.

Referring back to FIGS. 22-28, as mentioned above, endoscopic assembly400 includes an elongated shaft 420 extending distally from proximal hub410. Elongated shaft 420 includes a proximal end 422 secured to proximalhub 410 and a distal end 424 supporting first and second jaw members 460a, 460 b.

Drive assembly 430 includes an inner shaft 431 slidably supported withinthe interior of elongated shaft 420 and proximal hub 410. Inner shaft431 includes a proximal end 433 and a distal end 434. The proximal end433 of inner shaft 431 extends into internal bore 413 of proximal hub410 and is operably coupled to plunger 435 of drive assembly 430 viareceipt of transverse pin 436 of inner shaft 431 within longitudinalslots 437 of plunger 435. Distal end 434 of inner shaft 431 isconfigured to transition first and second jaw members 460 a, 460 b froman open position to a closed position to form a surgical clip (notshown) that has been loaded into first and second jaw members 460 a, 460b in response to distal translation of inner shaft 431 through elongatedshaft 420.

It is contemplated that inner shaft 431 may be split into a proximalportion and a distal portion in a similar manner as disclosed above withrespect to inner shaft 322. The components and operation of thisembodiment of inner shaft 431 are similar to that of inner shaft 322,and therefore, a detailed description of the components and operationthereof will not be described hereinbelow.

Drive assembly 430 further includes a stop ring 438 and first and secondbiasing members 439 a, 439 b, each of which is disposed about innershaft 431. Stop ring 438 is fixedly engaged about inner shaft 431 anddisposed within internal bore 413 of proximal hub 410. First biasingmember 439 a is positioned distally of stop ring 438 and is retainedbetween stop ring 438 and the distal end of proximal hub 410. Secondbiasing member 439 b is positioned proximally of stop ring 438 and isretained between stop ring 438 and the distal end of plunger 435. Firstbiasing member 439 a has a first spring constant “KK1” which is lessthan a second spring constant “KK2” of second biasing member 439 b, theimportance of which is detailed below.

The use of handle assembly 100 in conjunction with endoscopic assembly400 is now detailed with reference to FIGS. 8-14 and 22-28. Initially,endoscopic assembly 400 is engaged with handle assembly 100, as detailedabove. Since endoscopic assembly 400 is configured for ratcheting use ofratcheting drive assembly 130, ratchet pawl 142 remains disposed in theuse position upon engagement of endoscopic assembly 400 with handleassembly 100. More specifically, due to the relative positions anddimensions of ring-shaped aperture 414 of proximal hub 410 and sleeve152 of bypass assembly 150, as proximal hub 410 is inserted intoreceiver assembly 170, sleeve 152 is received within ring-shapedaperture 414, thereby enabling sleeve 152 to remain in its distal-mostposition under the bias of biasing member 154. With sleeve 152 remainingin its distal-most position, ratchet pawl 142 is retained in the useposition under the bias of pawl biasing member 146. Thus, as detailedbelow, ratcheting use of handle assembly 100 and endoscopic assembly 400is enabled. Once endoscopic assembly 400 and handle assembly 100 areengaged with ratchet pawl 142 remaining in the use position, handleassembly 100 and endoscopic assembly 400 are together ready for use.

In use, trigger 122 is initially disposed in the un-actuated positionunder the bias of biasing member 127. With trigger 122 disposed in theun-actuated position, drive bar 132 is disposed in a proximal-mostposition such that ratchet pawl 142 is disposed within distal recess 138of drive bar 132. Further, with drive bar 132 disposed in theproximal-most position, inner shaft 431 of drive assembly 430 isdisposed in a proximal-most position under the bias of first and secondbiasing members 439 a, 439 b, respectively. Thus, jaw members 460 a, 460b, initially, are disposed in the open position. With jaw members 460 a,460 b disposed in the open position, a new, unformed or open surgicalclip (not shown) may be located or loaded within jaw members 460 a, 460b, or may be otherwise operably positioned (manually or automatically)for insertion therebetween for formation or closure about tissue uponclosure of jaw members 460 a, 460 b. For example, in some embodiments,during firing, a surgical clip is first advanced from elongated shaft420 between jaw members 460 a, 460 b and, thereafter, jaw members 460 a,460 b are closed to form the surgical clip. In such embodiments, aseries of surgical clips may be loaded within elongated shaft 420 forsequential firing in a similar manner. However, other suitable surgicalclips and/or configurations for firing thereof are also contemplated.

In order to close, fire, or form the surgical clip loaded between jawmembers 460 a, 460 b, trigger 122 is urged from the un-actuated positionto the actuated position. More specifically, grasping portion 123 oftrigger 122 is pivoted towards fixed handle portion 112 of housing 110to urge linkage 128 distally which, in turn, urges drive bar 132distally. As drive bar 132 is urged distally, ratchet pawl 142 moves outof distal recess 138 of drive bar 132 and into engagement with ratchetrack 136. Once ratchet pawl 142 is engaged with ratchet rack 136,trigger 122 may not return towards the un-actuated position and, thus,drive bar 132 may not return proximally until trigger 122 reaches theactuated position, completing a full actuation stroke thereof.

As drive bar 132 is translated distally, drive bar 132 is advancedthrough housing 110, receiver assembly 170, and into bore 413 ofproximal hub 410 of endoscopic assembly 400. Eventually, drive bar 132contacts plunger 435 of drive assembly 430 of endoscopic assembly 400.Due to first spring constant “KK1” of first biasing member 439 a beingless than second spring constant “KK2” of second biasing member 439 b,as drive bar 132 is initially urged into plunger 435, plunger 435 andinner shaft 431 translate together distally such that first biasingmember 439 a is compressed while second biasing member 439 b remainssubstantially un-compressed. As inner shaft 431 is translated distally,a surgical clip is first loaded between first and second jaw members 460a, 460 b and, thereafter, first and second jaw members 460 a, 460 b aretransitioned from the open position to the closed position to form thesurgical clip about tissue, although other configurations are alsocontemplated.

As noted above with respect to endoscopic assembly 300 (FIGS. 15-21),depending upon the particular endoscopic assembly used, theconfiguration of the surgical clip being formed, and/or other factors,the required travel distance of inner shaft 431 to fully form thesurgical clip may vary. As also mentioned above, once ratchet pawl 142is engaged with ratchet rack 136, trigger 122 may not return towards theun-actuated position until trigger 122 reaches the actuated position,completing a full actuation stroke thereof. Thus, in order to enablereturn of trigger 122 to the un-actuated position in instances where therequired length of travel of drive bar 132 to fully form the surgicalclip is insufficient for ratchet pawl 142 to clear ratchet rack 136 andenter proximal recess 139 of drive bar 132, endoscopic assembly 400 mustallow further travel of drive bar 132, as detailed below.

As trigger 122 is further actuated to complete the full actuation strokethereof, plunger 435 is continued to be driven distally. However, sinceinner shaft 431 cannot travel further distally, second biasing member439 b is compressed, thus allowing plunger 435 to translate distallyindependently of inner shaft 431. That is, the compression of secondbiasing member 439 b enables inner shaft 431 to remain in position whilethe full actuation stroke of trigger 122 is completed.

Upon full actuation of trigger 122, e.g., upon reaching the actuatedposition of trigger 122, ratchet pawl 142 is moved into proximal recess139 of drive bar 132. With ratchet pawl 142 disposed within proximalrecess 139, trigger 122 may be released and returned to the un-actuatedposition under the bias of biasing member 127. Thereafter, theabove-detailed use may be repeated to close, fire, or form additionalsurgical clips.

Referring to FIGS. 30-35, an additional embodiment of a handle assemblyof an endoscopic assembly is provided. The handle assembly is generallyidentified by reference numeral 500, and is configured to increase amechanical advantage to the user during actuation of a movable handle520. Handle assembly 500 includes a housing 510, a movable handle 520, afirst linkage 530, and a second linkage 560. Movable handle 520, firstlinkage 530, and second linkage 560 cooperate to translate plunger 435with respect to housing 510.

A first portion 532 of first linkage 530 is pivotably connected to ahousing pin 512 of housing 510. A second portion 540 of first linkage530 is slidably connected to a pin 522 of movable handle 520. A thirdportion 550 of first linkage 530 is pivotably connected to secondlinkage 560. More particularly, housing pin 512 extends through (or atleast partially through) an aperture 534 defined within first portion532 of first linkage 530. Additionally, pin 522 of movable handle 520extends through (or at least partially through) a slot 542 definedwithin second portion 540 of first linkage 530. Further, a linkage pin570 extends through (or at least partially through) an aperture (hiddenfrom view in FIGS. 31-34) defined within third portion 550 of firstlinkage 530.

Additionally, as shown in FIG. 31, handle assembly 500 includes twosecond linkages 560 and 560′, where one second linkage 560 is disposedon a first lateral side of plunger 435, and the other second linkage560′ is disposed on a second lateral side of plunger 435. For purposesof brevity, only one second linkage 560 is described herein.

A first portion 562 of second linkage 560 is pivotably connected toplunger 435. A second portion 564 of second linkage 560 is pivotablyconnected to first linkage 530. More particularly, a plunger pin 442,disposed on plunger 435, extends through (or at least partially through)an aperture 563 defined within first portion 562 of second linkage 560.Additionally, linkage pin 570 extends through (or at least partiallythrough) an aperture 565 defined with second portion 564 of secondlinkage 560.

As shown in FIGS. 31-34, first linkage 530 defines a generally linearshape (between first portion 532 and second portion 540 thereof), andincludes a generally triangular extension (e.g., third portion 550)adjacent second portion 540. Additionally, as shown in FIGS. 32-34,second linkage 560 defines a generally linear shape (between firstportion 562 and second portion 564 thereof), and includes a V-likeportion 566 adjacent second portion 564. V-like portion 566 (e.g.,including a dip and a bump) is configured to prevent interferencebetween second linkage 560 and pin 522 of movable handle 520 (see FIG.32).

An initial, partial actuation of movable handle 520 causes handleassembly 500 to move from a first position (FIG. 32) to a secondposition (FIG. 33), which distally advances plunger 435 a firstdistance. In particular, the initial, partial actuation of movablehandle 520 causes first portion 532 of first linkage 530 to pivot abouthousing pin 512 of housing 510, causes slot 542 defined within secondportion 540 of first linkage 530 to slide with respect to pin 522 ofmovable handle 520, and causes pin 522 of movable handle 520 to urgesecond portion 540 of first linkage 530 in the general direction ofarrow “A” in FIG. 32 toward plunger 435 (e.g., plunger pin 442). Moreparticularly, the initial, partial actuation of movable handle 520 urgespin 522 of movable handle 520 into a sidewall 543 of slot 542, whichthus causes second portion 540 of first linkage 530 to move towardplunger 435. Additionally, the movement of second portion 540 of firstlinkage 530 relative to housing 510, also causes a correspondingmovement of third portion 550 of first linkage 530 with respect tohousing 510.

Further, the initial, partial actuation of movable handle 520 (and, inparticular, the movement of third portion 550 of first linkage 530)causes second portion 564 of second linkage 560 to pivot relative tothird portion 550 of first linkage 530 about linkage pin 570. Movementof third portion 550 of first linkage 530 also causes second portion 564of second linkage 560 to move toward plunger 435. The movement of secondportion 564 of second linkage 560 toward plunger 435 causes firstportion 562 of second linkage 560 to pivot about plunger pin 442 ofplunger 435, and thus cause plunger 435 to move distally.

A second, or continued actuation of movable handle 520 causes handleassembly 500 to move from the second position (FIG. 33) to a third(e.g., fully actuated) position (FIG. 34), which distally advancesplunger 435 a second distance. In particular, the continued actuation ofmovable handle 520 causes first portion 532 of first linkage 530 tocontinue to pivot about housing pin 512 of housing 510, causes slot 542of second portion 540 of first linkage 530 to slide with respect to pin522 of movable handle 520 (e.g., toward its initial position), andcauses pin 522 of movable handle 520 to move second portion 540 of firstlinkage 530 in the general direction of arrow “B” in FIG. 33 towardplunger 435 (e.g., plunger pin 442). Slot 542 slides with respect to pin522 of movable handle 520, toward its initial position, until pin 522contacts (or almost contacts) an end 544 of slot 542 (FIG. 34).Additionally, the continued movement of second portion 540 of firstlinkage 530 relative to housing 510, also causes a correspondingcontinued movement of third portion 550 of first linkage 530 withrespect to housing 510.

Further, the continued actuation of movable handle 520 (and, inparticular, the movement of third portion 550 of first linkage 530)causes second portion 564 of second linkage 560 to continue to pivotrelative to third portion 550 of first linkage 530 about linkage pin570, which causes continued movement of second portion 564 of secondlinkage 560 toward plunger 435, which thus causes continued pivoting offirst portion 562 of second linkage 560 about plunger pin 442 of plunger435, and continued distal movement of plunger 435.

FIG. 35 is a graph illustrating an example of the various amounts offorce (dynamic) required to actuate movable handle 520 with respect totime. The initial, partial actuation is indicated by reference characterIA, and the continued actuation is indicated by reference character CA.As shown, the amount of force required to actuate movable handle 520gradually increases throughout the actuation stroke. The inclusion ofhandle assembly 500 helps reduce the total amount of force necessary toactuate movable handle 520 thereof, as compared to a handle assemblylacking first linkage 530 and second linkage 540, for example. The graphalso illustrates, for the particular dimensions of linkages 530, 540,that a peak or maximum mechanical advantage of handle assembly 500 isabout 5.6:1, the minimum mechanical advantage of handle assembly 500 isabout 0.8:1, the average mechanical advantage of handle assembly 500 isabout 2.5:1, and the total stroke length is about 1.2 inches.

It is contemplated that the initial, partial actuation of movable handle520 results in a first function (e.g., insertion or loading of a firstclip), and that the continued actuation of movable handle 520 results ina second function (e.g., firing of the first clip).

It is contemplated, and within the scope of the present disclosure, thatother endoscopic assemblies, including a pair of jaws having a uniqueand diverse closure stroke length thereof, may be provided for use withhandle assembly 100 for ratcheting use or non-ratcheting use. Such aconfiguration accommodates various different endoscopic assemblieshaving different configurations and/or different closure stroke lengthswhile providing a constant actuation stroke length of trigger 122.Accordingly, various endoscopic assemblies, constructed in accordancewith the principles of the present disclosure, may be provided which arealso capable of firing or forming or closing surgical clips of varioussizes, materials, and configurations, across multiple platforms formultiple different manufactures.

Surgical instruments such as the clip appliers described herein may alsobe configured to work with robotic surgical systems and what is commonlyreferred to as “Telesurgery.” Such systems employ various roboticelements to assist the surgeon and allow remote operation (or partialremote operation) of surgical instrumentation. Various robotic arms,gears, cams, pulleys, electric and mechanical motors, etc. may beemployed for this purpose and may be designed with a robotic surgicalsystem to assist the surgeon during the course of an operation ortreatment. Such robotic systems may include remotely steerable systems,automatically flexible surgical systems, remotely flexible surgicalsystems, remotely articulating surgical systems, wireless surgicalsystems, modular or selectively configurable remotely operated surgicalsystems, etc.

The robotic surgical systems may be employed with one or more consolesthat are next to the operating theater or located in a remote location.In this instance, one team of surgeons or nurses may prep the patientfor surgery and configure the robotic surgical system with one or moreof the instruments disclosed herein while another surgeon (or group ofsurgeons) remotely control the instruments via the robotic surgicalsystem. As can be appreciated, a highly skilled surgeon may performmultiple operations in multiple locations without leaving his/her remoteconsole which can be both economically advantageous and a benefit to thepatient or a series of patients.

The robotic arms of the surgical system are typically coupled to a pairof master handles by a controller. The handles can be moved by thesurgeon to produce a corresponding movement of the working ends of anytype of surgical instrument (e.g., end effectors, graspers, knifes,scissors, etc.) which may complement the use of one or more of theembodiments described herein. The movement of the master handles may bescaled so that the working ends have a corresponding movement that isdifferent, smaller or larger, than the movement performed by theoperating hands of the surgeon. The scale factor or gearing ratio may beadjustable so that the operator can control the resolution of theworking ends of the surgical instrument(s).

The master handles may include various sensors to provide feedback tothe surgeon relating to various tissue parameters or conditions, e.g.,tissue resistance due to manipulation, cutting or otherwise treating,pressure by the instrument onto the tissue, tissue temperature, tissueimpedance, etc. As can be appreciated, such sensors provide the surgeonwith enhanced tactile feedback simulating actual operating conditions.The master handles may also include a variety of different actuators fordelicate tissue manipulation or treatment further enhancing thesurgeon's ability to mimic actual operating conditions.

Referring to FIG. 36, a medical work station is shown generally as workstation 1000 and generally may include a plurality of robot arms 1002,1003; a control device 1004; and an operating console 1005 coupled withcontrol device 1004. Operating console 1005 may include a display device1006, which may be set up in particular to display three-dimensionalimages; and manual input devices 1007, 1008, by means of which a person(not shown), for example a surgeon, may be able to telemanipulate robotarms 1002, 1003 in a first operating mode.

Each of the robot arms 1002, 1003 may include a plurality of members,which are connected through joints, and an attaching device 1009, 1011,to which may be attached, for example, a surgical tool “ST” supportingan end effector 1100, in accordance with any one of several embodimentsdisclosed herein, as will be described in greater detail below.

Robot arms 1002, 1003 may be driven by electric drives (not shown) thatare connected to control device 1004. Control device 1004 (e.g., acomputer) may be set up to activate the drives, in particular by meansof a computer program, in such a way that robot arms 1002, 1003, theirattaching devices 1009, 1011 and thus the surgical tool (including endeffector 1100) execute a desired movement according to a movementdefined by means of manual input devices 1007, 1008. Control device 1004may also be set up in such a way that it regulates the movement of robotarms 1002, 1003 and/or of the drives.

Medical work station 1000 may be configured for use on a patient 1013lying on a patient table 1012 to be treated in a minimally invasivemanner by means of end effector 1100. Medical work station 1000 may alsoinclude more than two robot arms 1002, 1003, the additional robot armslikewise being connected to control device 1004 and beingtelemanipulatable by means of operating console 1005. A medicalinstrument or surgical tool (including an end effector 1100) may also beattached to the additional robot arm. Medical work station 1000 mayinclude a database 1014, in particular coupled to with control device1004, in which are stored, for example, pre-operative data frompatient/living being 1013 and/or anatomical atlases.

Reference is made herein to U.S. Pat. No. 8,828,023 to Neff et al.,entitled “Medical Workstation,” the entire content of which isincorporated herein by reference, for a more detailed discussion of theconstruction and operation of an exemplary robotic surgical system.

It is contemplated, and within the scope of the present disclosure, thatother endoscopic assemblies, including a pair of jaws having a uniqueand diverse closure stroke length thereof, may be provided with a driveassembly, similar to any of the drive assemblies described herein, foraccommodating and adapting the closure stroke length for the pair ofjaws thereof to the constant trigger stroke length.

Accordingly, various endoscopic assemblies, constructed in accordancewith the principles of the present disclosure, may be provided which arealso capable of firing or forming or closing surgical clips of varioussizes, materials, and configurations, across multiple platforms formultiple different manufactures.

It should be understood that the foregoing description is onlyillustrative of the present disclosure. Various alternatives andmodifications can be devised by those skilled in the art withoutdeparting from the disclosure. Accordingly, the present disclosure isintended to embrace all such alternatives, modifications and variances.The embodiments described with reference to the attached drawing figuresare presented only to demonstrate certain examples of the disclosure.Other elements, steps, methods and techniques that are insubstantiallydifferent from those described above and/or in the appended claims arealso intended to be within the scope of the disclosure.

What is claimed is:
 1. A handle assembly for use with a surgicalinstrument, the handle assembly comprising: a housing; a movable handlepivotably mounted to the housing about a handle pin; a plunger disposedat least partially within the housing, wherein distal translation of theplunger relative to the housing is configured to affect a function ofthe surgical instrument; a first linkage disposed at least partiallywithin the housing, a first portion of the first linkage being pivotableabout the housing, a second portion of the first linkage being slidablerelative to the handle pin; and a second linkage disposed at leastpartially within the housing, a first portion of the second linkagebeing pivotable about the plunger, a second portion of the secondlinkage being pivotable about a third portion of the first linkage. 2.The handle assembly according to claim 1, wherein the second portion ofthe first linkage includes a slot, the handle pin being slidable withinthe slot.
 3. The handle assembly according to claim 1, wherein the firstportion of the second linkage is pivotable about a plunger pin, theplunger pin extending laterally from a proximal portion of the plunger.4. The handle assembly according to claim 1, wherein the plunger definesa longitudinal axis, and wherein the handle pin is disposed along thelongitudinal axis.
 5. The handle assembly according to claim 4, whereinthe handle pin is disposed proximally of a proximal-most end of theplunger.
 6. The handle assembly according to claim 1, wherein the secondportion of the second linkage is pivotable about the third portion ofthe first linkage and about a linkage pin.
 7. The handle assemblyaccording to claim 6, wherein when the movable handle is in anon-actuated position, the linkage pin is disposed proximally of thehandle pin.
 8. The handle assembly according to claim 7, wherein whenthe movable handle is in an actuated position, the linkage pin isdisposed distally of the handle pin.
 9. The handle assembly according toclaim 8, wherein when the movable handle is in a fully actuatedposition, the linkage pin and the handle pin are longitudinally aligned.10. The handle assembly according to claim 1, wherein the second linkageincludes a V-like portion configured to prevent interference between thesecond linkage and the handle pin.
 11. The handle assembly according toclaim 10, wherein the V-like portion of the second linkage is closer tothe second portion of the second linkage than the first portion of thesecond linkage.
 12. The handle assembly according to claim 3, whereinthe plunger pin is disposed distally of the handle pin throughout anentire actuation stroke of the movable handle.
 13. The handle assemblyaccording to claim 6, wherein the first portion of the second linkage ispivotable about a plunger pin, and wherein the plunger pin is disposeddistally of the linkage pin throughout an entire actuation stroke of themovable handle.
 14. The handle assembly according to claim 1, whereinthe first linkage is free from contact with the plunger throughout anentire actuation stroke of the movable handle.
 15. Than handle assemblyaccording to claim 1, wherein the plunger defines a longitudinal axis,and wherein the handle pin and the linkage pin are disposed on the sameside of the longitudinal axis as a majority of the movable handlethroughout an entire actuation stroke of the movable handle.